Healthcare Provider Details

I. General information

NPI: 1225533656
Provider Name (Legal Business Name): ASHLEY PESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE B129
LA JOLLA CA
92037-1731
US

IV. Provider business mailing address

3136 COURSER AVE
SAN DIEGO CA
92117-3607
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-0620
  • Fax:
Mailing address:
  • Phone: 402-890-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: